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Colorado MedicaidRAE Overview for Behavioral Health

ProvidersRegion 2 and Region 4

Presented by Provider RelationsMay 2018

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AgendaI. IntroductionsII. Accountable Care Collaborative OverviewIII. Regional Accountability Entity (RAE) Information IV. AuthorizationsV. ClaimsVI. CCARSVII. OverpaymentsVIII. Access to Care StandardsIX. CredentialingX. Q&A

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Accountable Care Collaborative

• Accountable Care Collaborative (ACC) is Health First Colorado’s primary health care program. It is designed to improve member's health and help them get the services they need to stay healthy.

• Accountable Care Collaborative Phase II (ACC 2.0) is the next iteration of the ACC, to leverage the proven successes of Colorado Medicaid’s programs to enhance the Health First Colorado member and provider experience. ACC 2.0 will go into effect on July 1, 2018.

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Overview

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RCCOs and BHOs end on 6/30/18 and RAE will start effective 7/1/18.

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What is a Regional Accountable Entity (RAE)?

In Colorado, Medicaid is called Health First Colorado.

Every Health First Colorado Member belongs to a RAE that manages their physical and behavioral health care.

The PCP is the member’s main contact for all of their health care.

Health First Colorado will assign all members to a PCP, but the member can choose another in-network provider at any time.

The member will be assigned to a RAE with whom the attributed PCP works. The RAE can also help the member use physical and behavioral health benefits and can help connect with providers.

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RAE Service Areas

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RAE Contact InformationREGION ENTITY CONTACT INFO

1 Rocky Mountain Health Planssupport@rmhpcommunity.org

Phone: 1-888-282-8801 (begin 7/1/2018)

2 Northeast Health Partnerscoproviderrelations@beaconhealthoptions.comPhone: 1-800-804-5040

3 Colorado Accesspns@coaccess.comPhone: 720-744-5487

4 Health Coloradocoproviderrelations@beaconhealthoptions.comPhone: 1-800-804-5040

5 Colorado Accesspns@coaccess.comPhone: 720-744-5487

6Colorado Community Health

Alliance

Contact Us

Phone: 303-256-1717 or 855-627-4685

7Colorado Community Health

Alliance

Contact Us

Phone: 303-256-1717 or 855-627-4685

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Source: HCPF Webinar: Phase II PCMP Contracting- presented 2/28/2018

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Member Attribution and PCMPs

Source: HCPF Webinar: Phase II PCMP Contracting- presented 2/28/2018

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Member AttributionWhy is it important for Members?• Members are required to be enrolled into ACC 2.0 • Ensures all members have a medical home • Enable HCPF to track the care of the member

Why is it important for Behavioral Health Providers?• Need to know what RAE a member is attributed to for authorizations

and payment• Care Coordination between physical and behavioral health services• Enables HCPF to track provider and RAE performance

Source: HCPF Webinar: Phase II PCMP Contracting- presented 2/28/2018

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InterChange 834 Enrollment FilesIn preparation for the next phase of ACC, the state will be processing the re-enrollment of all eligible Medicaid members throughout the month of May.What does that mean? It means that the Colorado InterChange will be setting member termination for current RCCOs, BHOs, MCOs, and PCMPs for June 30, 2018.At the same time, members will be re-enrolled with their PCMP or MCO and affiliated RAE with a July 1, 2018 enrollment start date.As a result, RCCOs, BHOs, MCOs, and PCMPs who use the 834 files generated by Colorado InterChange will be receiving files with all of these changes. If you have any questions, please contact the RAE or the state.

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Member Notices

• HCPF is working to send notification to Members about the RAE transition beginning on May 25th – June 5th .

• We will be showing an example of the letters- there is one for New enrollee and one for Current Enrollee.

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Member Notice - Initial Letter Current Enrollee

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Member Notice - Initial LetterNew Enrollee

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Behavioral Health Providers: Transition

For Authorizations and Claims through June 30, 2018o They will be facilitated and paid through the Behavioral Health Organization

(BHO) for dates of service through June 30, 2018.o Process for authorization and claims will remain the same.

• For Authorization and Claims beginning on July 1, 2018o They will be facilitated and paid through the Regional Accountable Entity (RAE)

— July 1, 2018- check the eligibility of the member to see what RAE they are attributed to make sure that you are contracted under the RAE for authorizations and claims payments.

— Check with the RAE on authorization and claims payment process.

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Continuation of Service and Transition

• Continuation of Service:o Providers should continue to provide covered services, to members in an inpatient

status or receiving active treatment through June 30, 2018 until the patient is discharged, even if that is beyond July 1, 2018; until Beacon Health Options makes reasonable and medically appropriate arrangement to have another provider render such services.

• Transition:o If the provider decides not to renew with Beacon Health Options, as of July 1, 2018,

the provider agrees to reasonably cooperate with Beacon Health Options to support the transition/or transfer of Members to another provider.

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Authorizations

Each RAE has its own authorization requirements.

Please visit the RAE websites for details of the authorization process. Information is available under Clinical Tools in the Provider section.

Northeast Health Partners:NortheastHealthPartners.org

Health Colorado:HealthColoradoRAE.com

Process for authorization may be subject to change under the RAE.

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Claims Overview

• Claims can be submitted through ProviderConnect or Batch 837 file through your Clearinghouse.

• Claims must be received within 90 days of the date of service, o or if there is other primary coverage, submit within 90 days of the primary

Explanation of Benefits (EOB).

• Claims received after the 90 day time period after the date of service may be denied due to lack of timely filing.

• If you do not agree with a payment of denial, you must submit a written request for reconsideration within 60 days of denial dateo sent to: Beacon Health Options, Attn: Health First Colorado Claims Appeals, P.O.

Box 1347, Latham, NY 12110

• For claims support, please call: 1-800-888-3944

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The Uniform Service Coding Standards Manual

• Behavioral health covered benefits are set by the USCSMo Mental Health Services o Substance Use Disorders (SUD)

• Updated periodicallyo TIP: Provider is responsible for rendering services using the most updated

information

• Can be accessed at: https://www.colorado.gov/pacific/hcpf/mental-health-rate-reform-0

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CCARsThe Colorado Client Assessment Record (CCAR) is a state-required form that must be completed for all members receiving behavioral health treatment. CCAR forms are not required if the only service being provided is for treatment of a covered substance use diagnosis. The CCAR form is used to capture demographic, administrative, clinical, and outcome data. It is a clinical instrument designed to assess the behavioral health status of a consumer in treatment.

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Overpayments

Providers should routinely review

claims and payments to assure that they have not received

any overpayments. Beacon will notify

providers of overpayments

identified by Beacon, clients or

government agencies.

Overpayments include, but are not limited to:

• Claims allowed/paid greater than billed

• Claims paid in error• Inpatient claim charges

equal to the allowed amounts

• Duplicate Payments• Payments made for

individuals whose benefit coverage is/was terminated

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Access to Care Standards• Behavioral Health Providers are required to render services to Members on

a timely basis, as follows: • Urgent Care – within twenty-four (24) hours after the initial identification of need.

• Outpatient follow-up appointments – within seven (7) days after discharge from a hospitalization. • Non-urgent Symptomatic Care Visit – within seven (7) days after the request.

• Well Care Visit – within one (1) month after the request; unless an appointment is required sooner to ensure the provision of screenings in accordance with the Department’s accepted Early Periodic Screening, Diagnostic and Treatment (EPSDT) schedules.

• Emergency Behavioral Health Care – by phone within fifteen (15) minutes after the initial contact, including TTY accessibility; in person within one (1) hour of contact in Urban and suburban areas, in person within two (2) hours after contact in Rural and Frontier areas.

• Non-urgent, Symptomatic Behavioral Health Services – within seven (7) days after a Member’s request. • Administrative intake appointments or group intake processes will not be considered as a treatment appointment for non-urgent symptomatic care. • The RAE will not place Members on wait lists for initial routine service requests.

• Administrative intake appointments or group intake processes will not be considered as a treatment appointment for non-urgent symptomatic care.

• The RAE will not place Members on wait lists for initial routine service requests.

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In Network Behavioral Health Providers

• A Silent Amendment will be sent to you via secure email.

—Written objections to this Amendment may be mailed electronically to the address below within thirty (30) days from the date of this letter:

COProviderRelations@beaconhealthoptions.como Once the thirty (30) day notice period has lapsed, Beacon will

consider your non-response as acceptance of this Amendment.

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In Network Behavioral Health Providers

CONTRACT• Review your current contract for the services and the practice locations for

which you currently are contracted.• Your amendment for Medicaid will cover the exact services and practice

locations of your current contract. • You can update practice locations in ProviderConnect:

o https://www.valueoptions.com/pc/eProvider/providerLogin.do

• You can request to add new services by email:o coproviderrelations@beaconhealthoptions.com

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In Network Behavioral Health Providers

CREDENTIALING• Your current credentialing status will transition to the RAE.

o For example: If you completed initial credentialing in May 2016, you must complete recredentialing prior to May 2019, otherwise your contract may be subject to termination.

• Your recredentialing packet will be sent to you via secure email 90 days before your recredentialing due date.

o Please respond with complete packet within 30 days; otherwise your contract may be subject to termination.

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Clean Credentialing Application

• CLEAN CREDENTIALING APPLICATION = updated CAQH, W9, Ownership Disclosure & Signed Contract

• CAQH –The Council for Affordable Quality Healthcare is a non-profit collaborative alliance of the nation’s leading health plans and networks.

• www.CAQH.org or call (888) 599-1771• You will need to give Beacon Health Options permission to access your

information. • No cost to providers to use CAQH, eliminates the need for time-

consuming paper forms. • Please keep your information out on CAQH updated.

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How to Join our Network

If you would like join our Medicaid network, here is what you need to do:

Please make sure that you are

enrolled/revalidated with the state for

Medicaid

Please complete the Request for Application (RFA) form available on the RAE websites:

Northeast Health Partners:NortheastHealthPartners.org

Health Colorado:HealthColoradoRAE.com

Send completed RFA to rfa@beaconhealthoptions.com

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Provider Relations for Region 2 and 4

Provider Relations is here to help you manage the transition.

Please contact us!Email: coproviderrelations@beaconhealthoptions.com

A Provider Relations Manager is available to meet with you in person.

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Additional Resources

Electronic Communication (via email) Quarterly Newsletter Periodic Provider Alerts

• Visit our Website— Clinical Tools— Provider Handbook— Practice Support Tools

Health Colorado: www.healthcoloradorae.comNortheast Health Partners: www.northeasthealthpartners.orgHCPF: https://www.colorado.gov/hcpf/accphase2

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Thank You